Totally Endoscopic Removal of a Sewing Needle Penetrating the Left Ventricle

Totally Endoscopic Removal of a Sewing Needle Penetrating the Left Ventricle | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Totally Endoscopic Removal of a Sewing Needle Penetrating the Left Ventricle Yoshinobu Watabe, Shun Watanabe, Masato Suzuki, Toshiro Ito This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7266561/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Mar, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 17 You are reading this latest preprint version Abstract Background: Intracardiac injuries caused by needles are rare and typically require removal via median sternotomy or limited thoracotomy. We present a case of successful removal using a totally endoscopic minimally invasive cardiac surgery (MICS) approach. Case Presentation: A 57-year-old woman presented with chest discomfort one day after falling and striking her left chest. Chest computed tomography revealed a fractured sewing needle, with one fragment embedded in the left ventricular myocardium and the other in the subcutaneous tissue. The patient remained hemodynamically stable, and removal was performed using a totally endoscopic MICS approach was performed. The intracardiac fragment was removed endoscopically without bleeding. The subcutaneous portion was extracted via a small skin incision. The postoperative course was uneventful, and the patient was discharged on day 5. Conclusion: Totally endoscopic MICS may be a safe and effective option for removing intracardiac foreign bodies in carefully selected patients. penetrating cardiac injury sewing needle cardiac injury minimally invasive cardiac surgery Figures Figure 1 Figure 2 Introduction Intracardiac injuries caused by foreign bodies such as needles are rare but reported[1-3]. Most cases have required surgical removal via median sternotomy or limited thoracotomy[4]. We present a case in which a fractured sewing needle penetrating the left ventricle (LV) was successfully removed using a totally endoscopic minimally invasive cardiac surgery (MICS) approach[5]. Case Presentation A 57-year-old woman presented with chest discomfort one day after falling and striking her left chest. Chest computed tomography (CT) revealed a fractured sewing needle, with one fragment embedded in the LV and the other located in the subcutaneous tissue of the left anterior chest (Figure 1a). The needle had traversed the LV wall while sparing both the left internal thoracic and anterior descending artery (Figure 1b). The patient remained hemodynamically stable and showed no signs of tamponade; therefore, a totally endoscopic MICS approach was selected. The patient was positioned in a 30-degree right lateral decubitus position. A 10-mm 30° oblique-view 3D thoracoscope (Karl Storz, Tuttlingen, Germany) was inserted through the fourth intercostal space on the left anterior-axillary line. Two 5-mm ports were placed at the third and fifth intercostal spaces on the left anterior chest. Hematoma around the anterior pericardial fat was evacuated, exposing the severed end of a sewing needle penetrating the pericardium (Figure 2a). The intra cardiac fragment was carefully extracted with a needle holder under direct thoracoscopic view. No bleeding was observed at the extraction site, and intraoperative transesophageal echocardiography (TEE) showed no increase in pericardial effusion (Video 1). The remaining subcutaneous fragment, which could not be accessed thoracoscopically, was removed via a small skin incision (Figure 2b, 2c). A 19 Fr Blake drain (Johnson & Johnson, New Brunswick, NJ, USA) was placed through the third intercostal port site. The postoperative course was uneventful. The chest drain was removed on day 2, and the patient was discharged on day 5. Discussion Penetrating cardiac injuries caused by foreign bodies, such as needles have been reported in previous literature.[1-3] In a review by Perrotta et al, 24 cases of needle-induced cardiac injury were analyzed. Most required open surgery via sternotomy or thoracotomy, and none were treated with a thoracoscopic approach.[4] The anatomical site of injury is a key factor influencing the risk of bleeding and need for surgical repair. In That review, approximately 11 cases involved the LV and 9 involved the right ventricle (RV). LV injuries, subject to higher ventricular pressure, more often required repair, while RV injuries were sometimes managed conservatively. Overall, about 40-50% of cases require myocardial repair. In our case, the needle was embedded within the anterior LV myocardium but did not cause active bleeding or pericardial effusion. This suggests that, in selected cases, thoracoscopic needle extraction from the LV myocardium may be feasible without repair. Several clinical factors supported the MICS approach. First, the patient was stable. Second, preoperative CT confirmed that the needle tip was embedded within the myocardium. Third, the anterior LV wall allowed clear thoracoscopic visualization, and if needed, conversion to an open procedure was considered feasible. Fourth, the femoral vessels were suitable for emergency extracorporeal circulation. These considerations helped mitigate the risk of hemorrhage and allowed us to proceed safely with a minimally invasive approach. Although myocardial repair has typically required open access, direct suturing or pledgeted repair may be feasible under thoracoscopic guidance in accessible areas. This case demonstrates that even LV injuries—typically considered high risk—may be suitable for thoracoscopic treatment in carefully selected patients. Further accumulation of similar cases will help clarify indications and safety margins for MICS in the setting of penetrating cardiac trauma Conclusions This case demonstrates that totally endoscopic MICS can be a viable and safe option for the removal of intracardiac foreign bodies in hemodynamically stable patients, offering reduced invasiveness and favorable recovery in selected cases. Abbreviations MICS minimally invasive cardiac surgery CT computed tomography LV left ventricle RV right ventricle TEE transesophageal echocardiography Declarations Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Conflict of interest: none declared Authors’ contributions: YW, SW, TI were major contributors in writing the manuscript. All authors read and approved of the final manuscript. Ethi cal statement : The patient provided written informed consent for the publication of this case report and accompanying images. The patient fully understood the nature of the case presentation and consented to the use of clinical information and images for academic and publication purposes. Data Abvailability Statement: All data generated or analyzed during this study are included in this published article and its supplementary materials. References Sanchez DR, Singh K, Heuser RR. Acupuncture needle in the heart. Tex Heart Inst J. 2017;44(6):426–8. Kanlerd A, Sujarittanakarn S, Lohitvisate W. Penetrating cardiac injury after percutaneous breast core-needle biopsy: an unusual life-threatening complication. J Med Case Rep. 2024;18(1):435. Di Paolo M, Gualniera P, Scoto G, Di Paolo M et al. Self-inserted needles in the heart. Am J Cardiol., Self-Inserted Needles in the Heart. Am J Cardiol, 2015. 116(8): pp. 1315-7. Perrotta S, Perrotta A, Lentini S. In patients with cardiac injuries caused by sewing needles, is the surgical approach the recommended treatment? Interact Cardiovasc Thorac Surg. 2010;10(5):783–92. Ito T, Yamaguchi M, Yamasaki N, et al. Minimally invasive valve surgery using high-resolution (3D) scope. Oper Tech Thorac Cardiovasc Surg. 2021;26(4):574–87. Additional Declarations No competing interests reported. Supplementary Files VideoJCTS.mp4 Video 1. Thoracoscopic removal of the needle from the LV myocardium. Cite Share Download PDF Status: Published Journal Publication published 09 Mar, 2026 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 24 Dec, 2025 Reviews received at journal 02 Sep, 2025 Reviews received at journal 30 Aug, 2025 Reviews received at journal 27 Aug, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers invited by journal 17 Aug, 2025 Editor assigned by journal 01 Aug, 2025 Submission checks completed at journal 01 Aug, 2025 First submitted to journal 31 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7266561","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":504158299,"identity":"d739fdc3-f77f-427f-8db3-13ef219c6382","order_by":0,"name":"Yoshinobu Watabe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYPCCAwxszIzNDz4AmWzsxGk4wMDPztxmOAOkhZlYLZL97A3SPCAeIS0GB3gMP3+ouSNncJixwdjm1zZ5PmYGxg8fc/BqMZY4cOyZMUjL49y+24ZtzAzMkjO34dPCu0HiANvhxA0gW3J7bjMCtbAx8+LXsvnHgX+H60FapC17btsTo2WbxMG2wwmSzUAtDD9uJxLUInmY/5vF2b5nhv3MjG2GvQ23k9uAEYTXL3zH25JvVHy7I8/Gf/zxgx9/btvOb28++OEjHi0Kh5F5jG1gsgG3eiCQR5X+g1fxKBgFo2AUjFAAAFIoWGsTTYt3AAAAAElFTkSuQmCC","orcid":"","institution":"Sapporo Kojinkai Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yoshinobu","middleName":"","lastName":"Watabe","suffix":""},{"id":504158300,"identity":"d49a93f2-390e-458c-b1a7-56a3c1cd1412","order_by":1,"name":"Shun Watanabe","email":"","orcid":"","institution":"Sapporo Kojinkai Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shun","middleName":"","lastName":"Watanabe","suffix":""},{"id":504158301,"identity":"7a36c0e3-c660-4bb2-9e1e-09e878217596","order_by":2,"name":"Masato Suzuki","email":"","orcid":"","institution":"Sapporo Kojinkai Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Masato","middleName":"","lastName":"Suzuki","suffix":""},{"id":504158302,"identity":"d1a18f52-85f8-42e0-a0ab-584dda389879","order_by":3,"name":"Toshiro Ito","email":"","orcid":"","institution":"Sapporo Kojinkai Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Toshiro","middleName":"","lastName":"Ito","suffix":""}],"badges":[],"createdAt":"2025-08-01 02:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7266561/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7266561/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-026-03939-8","type":"published","date":"2026-03-09T16:00:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89982444,"identity":"d3243a3b-3a9c-4907-8ee6-375ab432c29d","added_by":"auto","created_at":"2025-08-27 06:29:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1126027,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative CT images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003e Axial CT showing needle fragment embedded in the LV. (red circle)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(b)\u003c/strong\u003e 3D-CT showing two needle fragments (red circles) sparing both the left internal thoracic and anterior descending artery.\u003c/p\u003e\n\u003cp\u003eLAD, left anterior descending artery; LCx, left circumflex artery.\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-7266561/v1/1831499fa21f0aeae0fef1ea.png"},{"id":89980007,"identity":"ee0b895d-2274-4bbd-8803-776509a23b8d","added_by":"auto","created_at":"2025-08-27 06:21:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1743748,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003e Thoracoscopic view of the needle tip penetrating the pericardium. (black circle)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(b)\u003c/strong\u003e Extracted needle fragments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(c)\u003c/strong\u003eThe cosmetic result after the surgery.\u003c/p\u003e","description":"","filename":"Slide2.png","url":"https://assets-eu.researchsquare.com/files/rs-7266561/v1/c19243d499aa5ce058d1e6c9.png"},{"id":104739537,"identity":"4c622245-3abd-4e38-9e29-14ae280eb370","added_by":"auto","created_at":"2026-03-16 16:08:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3230757,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7266561/v1/26fcc906-ff30-4cf9-9f0b-e1541c136c67.pdf"},{"id":89980018,"identity":"406d804a-de37-4e44-ac50-30cffc885612","added_by":"auto","created_at":"2025-08-27 06:21:20","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":118461243,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eVideo 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThoracoscopic removal of the needle from the LV myocardium.\u003c/p\u003e","description":"","filename":"VideoJCTS.mp4","url":"https://assets-eu.researchsquare.com/files/rs-7266561/v1/c48285a6f336d119d7e89bf1.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Totally Endoscopic Removal of a Sewing Needle Penetrating the Left Ventricle","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntracardiac injuries caused by foreign bodies such as needles are rare but reported[1-3]. Most cases have required surgical removal via median sternotomy or limited thoracotomy[4]. We present a case in which a fractured sewing needle penetrating the left ventricle (LV) was successfully removed using a totally endoscopic minimally invasive cardiac surgery (MICS) approach[5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 57-year-old woman presented with chest discomfort one day after falling and striking her left chest. Chest computed tomography (CT) revealed a fractured sewing needle, with one fragment embedded in the LV and the other located in the subcutaneous tissue of the left anterior chest (Figure 1a).\u003c/p\u003e\n\u003cp\u003eThe needle had traversed the LV wall while sparing both the left internal thoracic and anterior descending artery (Figure 1b). The patient remained hemodynamically stable and showed no signs of tamponade; therefore, a totally endoscopic MICS approach was selected.\u003c/p\u003e\n\u003cp\u003eThe patient was positioned in a 30-degree right lateral decubitus position. A 10-mm 30° oblique-view 3D thoracoscope (Karl Storz, Tuttlingen, Germany) was inserted through the fourth intercostal space on the left anterior-axillary line. Two 5-mm ports were placed at the third and fifth intercostal spaces on the left anterior chest. Hematoma around the anterior pericardial fat was evacuated, exposing the severed end of a sewing needle penetrating the pericardium (Figure 2a). The intra cardiac fragment was carefully extracted with a needle holder under direct thoracoscopic view. No bleeding was observed at the extraction site, and intraoperative transesophageal echocardiography (TEE) showed no increase in pericardial effusion (Video 1). The remaining subcutaneous fragment, which could not be accessed thoracoscopically, was removed via a small skin incision (Figure 2b, 2c). A 19 Fr Blake drain (Johnson \u0026amp; Johnson, New Brunswick, NJ, USA) was placed through the third intercostal port site.\u003c/p\u003e\n\u003cp\u003eThe postoperative course was uneventful. The chest drain was removed on day 2, and the patient was discharged on day 5.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePenetrating cardiac injuries caused by foreign bodies, such as needles have been reported in previous literature.[1-3] In a review by Perrotta et al, 24 cases of needle-induced cardiac injury were analyzed. Most required open surgery via sternotomy or thoracotomy, and none were treated with a thoracoscopic approach.[4]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe anatomical site of injury is a key factor influencing the risk of bleeding and need for surgical repair. In That review, approximately 11 cases involved the LV and 9 involved the right ventricle (RV). LV injuries, subject to higher ventricular pressure, more often required repair, while RV injuries were sometimes managed conservatively. Overall, about 40-50% of cases require myocardial repair. In our case, the needle was embedded within the anterior LV myocardium but did not cause active bleeding or pericardial effusion. This suggests that, in selected cases, thoracoscopic needle extraction from the LV myocardium may be feasible without repair.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral clinical factors supported the MICS approach. First, the patient was stable. Second, preoperative CT confirmed that the needle tip was embedded within the myocardium. Third, the anterior LV wall allowed clear thoracoscopic visualization, and if needed, conversion to an open procedure was considered feasible. Fourth, the femoral vessels were suitable for emergency extracorporeal circulation. These considerations helped mitigate the risk of hemorrhage and allowed us to proceed safely with a minimally invasive approach.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough myocardial repair has typically required open access, direct suturing or pledgeted repair may be feasible under thoracoscopic guidance in accessible areas. This case demonstrates that even LV injuries—typically considered high risk—may be suitable for thoracoscopic treatment in carefully selected patients. Further accumulation of similar cases will help clarify indications and safety margins for MICS in the setting of penetrating cardiac trauma\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis case demonstrates that totally endoscopic MICS can be a viable and safe option for the removal of intracardiac foreign bodies in hemodynamically stable patients, offering reduced invasiveness and favorable recovery in selected cases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMICS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eminimally invasive cardiac surgery\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecomputed tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eleft ventricle\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eright ventricle\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTEE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003etransesophageal echocardiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e none declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e YW, SW, TI were major contributors in writing the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthi\u003c/strong\u003e\u003cstrong\u003ecal statement\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The patient provided written informed consent for the publication of this case report and accompanying images. The patient fully understood the nature of the case presentation and consented to the use of clinical information and images for academic and publication purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Abvailability Statement:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are included in this published article and its supplementary materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSanchez DR, Singh K, Heuser RR. Acupuncture needle in the heart. Tex Heart Inst J. 2017;44(6):426\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKanlerd A, Sujarittanakarn S, Lohitvisate W. Penetrating cardiac injury after percutaneous breast core-needle biopsy: an unusual life-threatening complication. J Med Case Rep. 2024;18(1):435.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDi Paolo M, Gualniera P, Scoto G, Di Paolo M et al. Self-inserted needles in the heart. Am J Cardiol., Self-Inserted Needles in the Heart. Am J Cardiol, 2015. 116(8): pp. 1315-7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerrotta S, Perrotta A, Lentini S. In patients with cardiac injuries caused by sewing needles, is the surgical approach the recommended treatment? Interact Cardiovasc Thorac Surg. 2010;10(5):783\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIto T, Yamaguchi M, Yamasaki N, et al. Minimally invasive valve surgery using high-resolution (3D) scope. Oper Tech Thorac Cardiovasc Surg. 2021;26(4):574\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"penetrating cardiac injury, sewing needle cardiac injury, minimally invasive cardiac surgery","lastPublishedDoi":"10.21203/rs.3.rs-7266561/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7266561/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIntracardiac injuries caused by needles are rare and typically require removal via median sternotomy or limited thoracotomy. We present a case of successful removal using a totally endoscopic minimally invasive cardiac surgery (MICS) approach.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCase Presentation:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA 57-year-old woman presented with chest discomfort one day after falling and striking her left chest. Chest computed tomography revealed a fractured sewing needle, with one fragment embedded in the left ventricular myocardium and the other in the subcutaneous tissue. The patient remained hemodynamically stable, and removal was performed using a totally endoscopic MICS approach was performed. The intracardiac fragment was removed endoscopically without bleeding. The subcutaneous portion was extracted via a small skin incision. The postoperative course was uneventful, and the patient was discharged on day 5.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTotally endoscopic MICS may be a safe and effective option for removing intracardiac foreign bodies in carefully selected patients.\u003c/p\u003e","manuscriptTitle":"Totally Endoscopic Removal of a Sewing Needle Penetrating the Left Ventricle","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:21:10","doi":"10.21203/rs.3.rs-7266561/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-24T17:08:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-02T12:31:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-31T00:40:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T13:52:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220782479444020362199097309194690149887","date":"2025-08-25T18:38:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303557821089830588449714439973039441450","date":"2025-08-20T00:21:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T13:37:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T05:45:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7392253313073444032296383918942311422","date":"2025-08-19T05:20:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304177564257394538038100569716412743517","date":"2025-08-19T05:00:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309555501222615538768182024735945229726","date":"2025-08-17T16:56:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264796034035321395463108086622739344614","date":"2025-08-17T13:20:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137472882699151906779671000495555863097","date":"2025-08-17T11:55:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-17T10:18:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-02T03:42:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-02T03:41:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-08-01T02:08:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f942f7af-fafc-410b-a7b5-7948c5630b2a","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:04:20+00:00","versionOfRecord":{"articleIdentity":"rs-7266561","link":"https://doi.org/10.1186/s13019-026-03939-8","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2026-03-09 16:00:16","publishedOnDateReadable":"March 9th, 2026"},"versionCreatedAt":"2025-08-27 06:21:10","video":"","vorDoi":"10.1186/s13019-026-03939-8","vorDoiUrl":"https://doi.org/10.1186/s13019-026-03939-8","workflowStages":[]},"version":"v1","identity":"rs-7266561","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7266561","identity":"rs-7266561","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}